National cohort study on postoperative risks after surgery for submucosal invasive colorectal cancer

Vermeer, Nina C.A.; Backes, Yara; Snijders, H.S.; Bastiaannet, E.; Liefers, Gerrit‐Jan; Moons, Leon M.G.; Velde, Cornelis J.H. van de; Peeters, Koen

doi:10.1002/bjs5.50125

Cited by 44 publications

(51 citation statements)

References 32 publications

(28 reference statements)

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“…Male patients also showed the likelihood of increased postoperative complications. Previous studies have found that the rate of postoperative complications was significantly higher in male patients than that in female patients (34,35). The feature selection method showed no evidence of a patient's age being associated with prolonged LOS for patients undergoing CRC surgery.…”

Section: Discussionmentioning

confidence: 77%

Use of Machine Learning and Statistical Algorithms to Predict Hospital Length of Stay Following Colorectal Cancer Resection: A South African Pilot Study

et al. 2021

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The aim of this pilot study was to develop logistic regression (LR) and support vector machine (SVM) models that differentiate low from high risk for prolonged hospital length of stay (LOS) in a South African cohort of 383 colorectal cancer patients who underwent surgical resection with curative intent. Additionally, the impact of 10-fold cross-validation (CV), Monte Carlo CV, and bootstrap internal validation methods on the performance of the two models was evaluated. The median LOS was 9 days, and prolonged LOS was defined as greater than 9 days post-operation. Preoperative factors associated with prolonged LOS were a prior history of hypertension and an Eastern Cooperative Oncology Group score between 2 and 4. Postoperative factors related to prolonged LOS were the need for a stoma as part of the surgical procedure and the development of post-surgical complications. The risk of prolonged LOS was higher in male patients and in any patient with lower preoperative hemoglobin. The highest area under the receiving operating characteristics (AU-ROC) was achieved using LR of 0.823 (CI = 0.798–0.849) and SVM of 0.821 (CI = 0.776–0.825), with each model using the Monte Carlo CV method for internal validation. However, bootstrapping resulted in models with slightly lower variability. We found no significant difference between the models across the three internal validation methods. The LR and SVM algorithms used in this study required incorporating important features for optimal hospital LOS predictions. The factors identified in this study, especially postoperative complications, can be employed as a simple and quick test clinicians may flag a patient at risk of prolonged LOS.

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Section: Discussionmentioning

confidence: 77%

Use of Machine Learning and Statistical Algorithms to Predict Hospital Length of Stay Following Colorectal Cancer Resection: A South African Pilot Study

et al. 2021

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“…In this sense, it is relevant to improve the resection skills of the endoscopists in order to evaluate which lesions are at risk of harboring an invasive CRC candidate for endoscopic resection and, in any case, obtain a complete endoscopic resection according to the characteristics of the lesion. It is important to remind that endoscopic resection must enable the evaluation of the resection border [19,29]. As we have shown in this analysis, this is one of the discriminant variables associated with the risk of residual disease after endoscopic resection.…”

Section: Discussionmentioning

confidence: 82%

“…Moreover, surgery allows resecting completely and, thus, evaluates both the colon wall and the regional lymph nodes. Although it is associated with a low mortality risk, especially in the laparoscopic approach [19], it produces relevant short-and long-term complications [20]. Traditionally, in the decision-making analysis, the risk of death after surgery has been confronted with the risk of residual disease after endoscopic resection [17].…”

Section: Discussionmentioning

confidence: 99%

pT1 Colorectal Cancer Detected in a Colorectal Cancer Mass Screening Program: Treatment and Factors Associated with Residual and Extraluminal Disease

Cubiella

González

Almazán

et al. 2020

Cancers

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The aim of this study is to describe the treatment of pT1 colorectal cancer (CRC) in a mass screening program, the surgery-related complications and the factors associated with residual disease after endoscopic resection and extraluminal disease after surgery. We included in this retrospective analysis all the pT1 CRC detected in the Galician CRC screening program between May 2013 and June 2019. We determined which variables were independently associated with the outcomes of the study through a multivariable logistic regression analysis. We included 370–354 pT1 N0(X), 16 pT1N1- out of the 971 CRC detected; 277 (74.9%) were resected endoscopically and 162 (43.8%) were not referred to surgery. There were surgical complications in 30.7% and 16.3% of the patients during hospitalization and after discharge. Residual disease was detected in 12 (4.3%) after endoscopic resection and extraluminal disease in 18 (8.6%) patients after surgery. The variables independently associated with initial endoscopic resection were a pedunculated morphology (OR 33.1, 95% CI 4.3–254), a diameter ≥ 20 mm (OR 3.94, 95% CI 1.39–11.18) and a Site–Morphology–Size–Access score < 9 (OR 428, 95% CI 42–4263). The variables related with surgery rescue were a piecemeal resection (OR 4.48, 95% CI 1.48–13.6), an infiltrated/nonevaluable resection border (OR 7.44, 95% CI 2.12–26.0), a non-well-differentiated histology (OR 4.76, 95% CI 1.07–20.0), vascular infiltration (OR 8.24, 95% CI 2.72–25.0) and a Haggitt 4 infiltration of the submucosa (OR 5.68, 95% CI 2.62–12.3). Residual disease after endoscopic resection was associated with an infiltrated/nonevaluable resection border (OR 34.9, 95% CI 4.08–298), a non-well-differentiated histology (OR 6.67, 95% CI 1.05–50.0), and the vascular infiltration of the submucosa (OR 7.61, 95% CI 1.55–37.4). The variables related with extraluminal disease after surgical resection were no endoscopic resection (OR 4.34, 95% CI 1.26–14.28), a non-well-differentiated histology (OR 4.35, 95% CI 1.39–14.29) and the lymphatic infiltration of the submucosa (OR 4.8, 95% CI 1.32–17.8). In a CRC screening program, although most of pT1 CRC are candidates for endoscopic treatment, surgery is a safe procedure. We have defined some easy to evaluate variables that can be used in the decision-making process.

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“…[14][15][16][17][18][19][20][21][22][23] Most patients without LNM are routinely exposed to the risk of surgical resection with an associated postoperative mortality rate of 1.5% to 2% and no clinical benefit. 24 To reduce these unnecessary surgical resections and provide patients with proper treatment without excess or deficiency, development of a more accurate prediction model for LNM is necessary.…”

Section: Introductionmentioning

confidence: 99%

Risk Stratification of T1 Colorectal Cancer Metastasis to Lymph Nodes: Current Status and Perspective

et al. 2021

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With the widely spreading population-based screening programs for colorectal cancer and recent improvements in endoscopic diagnosis, the number of endoscopic resections in subjects with T1 colorectal cancer has been increasing. Some reports suggest that endoscopic resection prior to surgical resection of T1 colorectal cancer has no adverse effect on prognosis and contributes to this tendency. The decision on the need for surgical resection as an additional treatment after endoscopic resection of T1 colorectal cancer should be made according to the metastasis risk to lymph nodes based on histopathological findings. Because lymph node metastasis occurs in approximately 10% of patients with T1 colorectal cancer according to current international guidelines, the remaining 90% of patients may be at an increased risk of surgical resection and associated postoperative mortality, with no clinical benefit derived from unnecessary surgical resection. Although a more accurate prediction system for lymph node metastasis is needed to solve this problem, risk stratification for lymph node metastasis remains controversial. In this review, we focus on the current status of risk stratification of T1 colorectal cancer metastasis to lymph nodes and outline future perspectives.

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National cohort study on postoperative risks after surgery for submucosal invasive colorectal cancer

Cited by 44 publications

References 32 publications

Use of Machine Learning and Statistical Algorithms to Predict Hospital Length of Stay Following Colorectal Cancer Resection: A South African Pilot Study

Use of Machine Learning and Statistical Algorithms to Predict Hospital Length of Stay Following Colorectal Cancer Resection: A South African Pilot Study

pT1 Colorectal Cancer Detected in a Colorectal Cancer Mass Screening Program: Treatment and Factors Associated with Residual and Extraluminal Disease

Risk Stratification of T1 Colorectal Cancer Metastasis to Lymph Nodes: Current Status and Perspective

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